Published reports have indicated that prodromal angina before acute
myocardial infarction (AMI) is associated with better outcomes and that
nicorandil has cardioprotective effects on ischemic hearts. We compared cardioprotective effects of intravenous
nicorandil with preconditioning effects by prodromal angina in patients with AMI who underwent
percutaneous coronary intervention (PCI). In total, 368 patients with first ST-elevation AMI who underwent PCI were randomly assigned to receive
nicorandil 12 mg or a placebo intravenously just before PCI. Subjects were assigned to 1 of 4 groups: 52 patients with prodromal angina were given placebo, 129 patients without prodromal angina were given
nicorandil, 56 patients with prodromal angina were given
nicorandil, and 131 patients without prodromal angina were given placebo. Coronary microvascular impairment after PCI was prevented at similar frequencies in groups with prodromal angina and groups on
nicorandil. Five-year rates for freedom from major
cardiac events were similar across groups with prodromal angina given placebo, without prodromal angina given
nicorandil, and with prodromal angina given
nicorandil (92.3%, 93.8%, and 92.9%, respectively) but were significantly lower in the group without prodromal angina given placebo (80.2%, p = 0.0019, 0.044, and 0.042, respectively). In conclusion,
intravenous administration of
nicorandil before PCI exerts pharmacologic cardioprotective effects similar to ischemic preconditioning in patients with AMI.